• Alberto Zangrillo, Elena Bignami, Beatrice Noè, Pasquale Nardelli, Margherita Licheri, Chiara Gerli, Martina Crivellari, Alessandro Oriani, Ambra Licia Di Prima, Evgeny Fominskiy, Nora Di Tomasso, Rosalba Lembo, Giovanni Landoni, Giuseppe Crescenzi, and Fabrizio Monaco.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
• J. Cardiothorac. Vasc. Anesth. 2021 Apr 1; 35 (4): 1106-1114.

ObjectiveTo assess whether the administration of the ultra-short-acting β-blocker esmolol in cardiac surgery could have a cardioprotective effect that translates into improved postoperative outcomes.DesignSingle-center, double-blinded, parallel-group randomized controlled trial.SettingA tertiary care referral center.ParticipantsPatients undergoing elective cardiac surgery with preoperative evidence of left ventricular end-diastolic diameter >60 mm and/or left ventricular ejection fraction <50%.InterventionsPatients were assigned randomly to receive either esmolol (1 mg/kg as a bolus before aortic cross-clamping and 2 mg/kg mixed in the cardioplegia solution) or placebo in a 1:1 allocation ratio.Measurements And Main ResultsThe primary composite endpoint of prolonged intensive care unit stay and/or in-hospital mortality occurred in 36/98 patients (36%) in the placebo group versus 27/102 patients (27%) in the esmolol group (p = 0.13). In the esmolol group, a reduction in the maximum inotropic score during the first 24 postoperative hours was observed (10 [interquartile range 5-15] v 7 [interquartile range 5-10.5]; p = 0.04), as well as a trend toward a reduction in postoperative low-cardiac-output syndrome (13/98 v 6/102; p = 0.08) and the rate of hospital admission at one year (26/95 v 16/96; p = 0.08). A trend toward an increase in the number of patients with ejection fraction ≥60% at hospital discharge also was observed (4/95 v 11/92; p = 0.06).ConclusionsIn the present trial, esmolol as a cardioplegia adjuvant enhanced postoperative cardiac performance but did not reduce a composite endpoint of prolonged intensive care unit stay and/or mortality.Copyright © 2020 Elsevier Inc. All rights reserved.

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